Pioneering gerontologist Dr Robert N. Butler, the first director of the US National Institute on Ageing, opened his 1977 research paper Exercise, the Neglected Therapy with the following words: “If exercise could be packed in a pill, it would be the single most widely prescribed and beneficial medicine.” These words succinctly sum up the importance of physical activity as a form of preventive and remedial health care for the ageing population.
Indeed, data from the World Economic Forum has shown that average global life expectancy has risen from 46 years in 1950 to 72 years in 2022. In order to live a longer life of higher quality, both financial and physical well-being are required. These would involve efforts and contributions from different stakeholders like the government, financial institutions, employers, etc. However, another key factor in living a life of good quality is the upkeeping of one’s health. In this aspect, exercise – in whatever forms – is key.
SEDENTARY VS ACTIVE LIFESTYLE
Being sedentary brings ill effects to one’s health. The WHO (World Health Organisation) reported that 6% of premature mortality is related to physical inactivity; it is also the 4th leading global risk factor for death in middle-to-high income countries like Singapore (first being high blood pressure, followed by cigarette smoking and then high blood sugar levels). In fact, being unfit is an independent risk factor for cardiovascular disease as well.
In contrast, achieving recommended physical activity levels has consistently been shown to bring a myriad of health benefits. Regular physical activities not only reduce the risk of cardiovascular disease, but they also reduce the risk of cancer and osteoporosis. Furthermore, being active also improves cognitive function and psychological well-being. A long-term study with up to 34 years of follow-up found that the most physically active individuals lived 7 to 8 years longer than their less active peers. This is an impressive number!
Older adults often face the problem of losing muscle mass and strength, a condition known as sarcopenia. Again, physical activities like resistance training, coupled with a high protein diet, can help to fight against sarcopenia. The good news is that it is never too late to start to move our muscles. One study found that even people over 80 can build muscle and strength by starting regular resistance training.
Screening for underlying cardiovascular disease can be useful for individuals who intend to start exercising. This is especially important for inactive individuals with multiple cardiovascular risk factors like diabetes mellitus or smoking. Similarly, for people with a family history of early cardiovascular disease, pre-exercise screening should be considered. The usual screening tools for cardiovascular disease include ultrasound scan of the heart (echocardiogram) and exercise stress testing.
Some may think that longevity is very much linked to our genetic makeup. This is not really the case. In my practice, it is not uncommon to hear patients say things like: “Both my parents have already lived to 80 years old. I have good genes, so I am going to live for as long as they have, probably even more!” This is usually just an excuse to remain physically inactive. Research from the Danish Twin Study has shown that genes dictate only 20% of longevity, while lifestyle and environment account for the rest. So, if you truly believe that you are destined for a long and healthy life based on your genes alone, you will be in for a rude shock.
WHO RECOMMENDATIONS
In 2020, WHO made the recommendation that adults should do at least 150-300 minutes of moderate-intensity aerobic physical activity, or 75-150 minutes of vigorous-intensity aerobic physical exercise, or an equivalent combination of moderate- and vigorous-intensity activity throughout the week.
Moderate-intensity activities can include exercises like brisk walking, cycling or swimming, with a noticeable increase in heart rate. On the other hand, vigorous-intensity activities are typified by jogging or running, which cause a significant increase in heart rate and rapid breathing. Beyond the above recommendation, WHO also recommends having muscle-strengthening activities at moderate or greater intensity that involve all major muscle groups on two or more days a week. Exceeding the minimum recommended amount of physical activity would bring additional health benefits.
CAN YOU HAVE TOO MUCH OF A GOOD THING?
For those who exercise regularly, you may wonder about the potential risk of exercising “excessively”: can we actually have too much of a good thing? Well, intense, regular high volume physical training may enlarge the chambers of our heart and sometimes, also thicken the heart muscle wall. There may also be ECG (electrocardiogram) changes. These changes are due to the physiological adaptation of our heart to the regular induced physical stress. These changes are benign and are known as “athlete’s heart”.
In terms of cardiovascular problems that athletes may encounter, rhythm abnormality or more specifically, atrial fibrillation (AF), is the most common. The frequency of AF has been estimated to be 2-10 times greater in high-intensity endurance athletes compared to sedentary individuals. However, regular mild- to moderate-intensity exercise can protect one from cardiovascular disease and AF. Premature ventricular contractions (PVCs) are also quite common in the athletic population.
Middle-aged and older male athletes may also have increased coronary artery calcification (CAC) and atherosclerotic plaques, which are related to the amount and intensity of lifelong exercise. The cardiovascular risk associated with coronary atherosclerosis in athletes and how it differs from the general population is still uncertain at this point.
SCREENING
It should be noted that there is a higher risk of sudden death for sedentary individuals who suddenly and abruptly participate in vigorous exercise. Hence, anyone who is keen to start an exercise training regime is advised to do so slowly and build up their physical fitness gradually.
Screening for underlying cardiovascular disease can be useful for individuals who intend to start exercising. This is especially important for inactive individuals with multiple individuals with multiple cardiovascular risk factors like diabetes mellitus or smoking. Similarly, for people with a family history of early cardiovascular disease, pre-exercise screening should be considered.
The usual screening tools for cardiovascular disease include ultrasound scan of the heart (echocardiogram) and exercise stress testing. Depending on the findings of the initial screening, additional tests may be necessary.
CONCLUSION
In a nutshell, exercise is the magic bullet for leading a long and healthy life. Its benefit extends beyond cardiovascular health; it also reduces risk of chronic diseases like hypertension, improves mental health, enhances cognitive function and even lowers the chance of many types of cancer like breast cancer. Let’s start to embark on this journey of health together! PRIME
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